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Are You Familiar With Your Specialty Tiering?

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The objective of the Optum® Clinical Support Program is to facilitate the adoption of current best evidence into practice, leading to less variation in decision-making and resulting in more affordable and higher quality health care services. To accomplish this, Optum has developed an integrated set of outreach activities based on the degree to which an individual provider’s decision-making varies from that of peers and current best evidence.

One way we identify providers who would benefit from our outreach activities is through a tiered network environment. The tier criteria, illustrated below, used to identify tiers within the Optum network are developed and approved by a series of committees, each consisting of external providers and subject matter experts from active practice, academic institutions and professional licensing bodies. When evaluating tiering criteria, we consider characteristics of the treated patient population to ensure the case mix does not adversely impact the tier assignments. For additional information on tiering, please consult the Provider Operations Manual at www.myoptumhealthphysicalhealth.com.

Chiropractic Tiering Chart Below


PT / OT Tiering Chart Below

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